wellness

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No, you didn’t read the headline wrong. This is not the “corner office workout,” for the elite who occupy spacious private offices. This is the “office corner workout” for cubicle-dwelling plebes who occupy space only as wide as our arm-spans, and pop up like prairie dogs to confer with each other.

In our class, there’s often not enough floor space to do a push-up or a crunch without risk of being run over by an oblivious colleague’s office chair. But here, Rick DiScipio, assistant manager of Boston University’s FitRec Center, demonstrates the minimalist glory of the simple but powerful moves we can do at or near our desks. (If, that is, we can also establish a workplace culture that accepts our colleagues’ quiet exertions.)

Why bother? Sitting is the new smoking (sort of). Even dribs and drabs of activity can improve your health. (A study last year suggested even two minutes an hour of light activity can have an effect.) And if you have to be a worker bee, at least you can be a fitter worker bee. More rationales later. First, the workout.

Stand just in front of a chair with feet about shoulder-width apart. Slowly squat until you sit in the chair for a second, then stand back up again. For more challenge, put one foot in front of the other or — if very fit — try it one-legged. Two sets of 12.

3) Leg Extension

DiScipio shows WBUR staff a leg extension. (Robin Lubbock/WBUR)

Sit in a chair and fully extend one leg, then the other. Two sets of 12.

That’s what some fitness-types are saying. Consumers can access exercise programs of all stripes. From old-world Jack LaLanne to ’80s Jane Fonda, from Insanity to the current YouTube HIIT (high intensity interval training) sessions — the American fitness diet continues to evolve. At the moment, it’s all about free and on-demand.

When Cassey Ho made her first YouTube exercise video, she had her pilates students in mind. Thirty of them. It was 2009 and Ho had recently moved from California to Boston to try a career in fashion buying. A few months later, she checked in on that YouTube video and there were thousands of views.

So she decided to make more.

The Blogilates App allows users to search for fellow “POPsters” in their area. (Courtesy of Cassey Ho/Blogilates)

By 2011, Cassey Ho was posting one video a week, calling her unique brand of pilates “POP Pilates,” essentially pilates to pop music. She named her channel “Blogilates” and an empire was born. Today, Cassey Ho was 1.8 million subscribers to her YouTube channel — 60,000 page views a day and 8 million views a month.

Ho credits humility as key to her success. “I think the reason for it’s [Blogilates] growth is the fact that I love teaching. I genuinely want to help people.”

Reach people she does — Blogilates is now the top fitness channel on the network. Ho also has a book deal, a DVD release and more original designs from her clothing line in the works for 2015.

YouTube has become the DIY video destination, from cupcakes to cosmopolitans, appliance repairs and yes — ab workouts — there’s a video for every problem. Even armpit fat. Huge audiences combined with social media savvy has made the everyday people who dole out this advice into celebrities. “People cry and shake and get crazy when they see me,” says Ho. She occasionally does tours to give live classes around the country. “When you go to Blogilates meet-ups, there are hundreds of people there and I get to hear their stories…and how these videos helped them battle eating disorders, lose a ton of weight. They are so positive and kind — they don’t mind having to wait five hours in line to meet me. They make me want to work harder.”

And it’s these young enthusiastic fans that are driving the YouTube content bonanza. In the first quarter of 2014, according to Nielsen, consumers aged 18-24 viewed 2 hours and 28 minutes of online videos per week — that’s nearly an hour more than the average for all adults.

Cassey Ho isn’t alone. There’s the two friends behind “Tone It Up,” Elliot Hulse who creates videos like “Exercise for Heartbreak and Pain,” and the husband and wife team behind “Fitness Blender” (known simply as Daniel and Kelli). Daniel and Kelli started their channel in their garage — in fact they still record videos there.

According to OpenSlate, a video analytics platform that analyzes all ad-supported content on YouTube, Fitness Blender averages around 8 million views per month. In an introduction video, Daniel explains that they started their channel because they “there weren’t any fitness websites out there that actually focused on fitness — they were all about make-up, all about clothes, all about what you look like — not about what you do.” Kelli adds that “everyone should have access to health fitness information regardless of their income or access to a gym.”

Tolga Ozyurtcu, a clinical assistant professor in the department of kinesiology and health education at the University of Texas at Austin, says the YouTube brand of exercise is more “personalized and more personal.

“In the past, the marketplace of exercise television or videos had to be more middle-ground…the new stuff is hyper-focused.” Continue reading →

As decreed in the state’s latest health reform law, Massachusetts will spend a total of $60 million dollars over the next several years on trying to stop health spending before it happens — by keeping people healthier. Of that $60 mllion total, $43 million goes to competitive grants, and if you’ve got a brilliant idea, you can now apply for one.

I must say, prevention money so often gets short shrift when it comes to health budgets that I’m pleasantly surprised to see that the state’s “Prevention and Wellness Trust Fund” did not fall victim to any sort of fiscal knifery. And I can’t wait to see what people come up with.

The folks at the Massachusetts Public Health Association, which led the effort to create the trust fund, kindly sent over the state document below laying out the basics on the grants. And if you want to actually apply, you must navigate the terrifying jungles of the state procurement system; you can try going to this page and typing “Prevention and Wellness Trust” into the search box. I just tried it and it worked for me (just as a test — we’re not competitors; so if you think your idea is so cool it deserves CommonHealth coverage, give us a yell…)

Massachusetts Prevention and Wellness Trust Fund

· Funding available: $42,750,000 over 4 years

· Goal: to reduce healthcare costs in the Commonwealth by supporting evidence-based community and clinical prevention strategies and providing activities that will simultaneously decrease preventable risk factors and illness and improve the management of existing chronic disease.

If Nebraska’s public relations blitz about the success of its wellness program is to be believed, state employees have sixty times the cancer incidence of former residents of Love Canal. The only other interpretation is that, in the name of wellness, state employees were subject to the most overdiagnosis and overtreatment ever documented — at taxpayer expense, no less.

Here is the one fact known to the public. Prompted by a mass mailing and copay waivers encouraging them to go get cancer screens, 514 of the participating state employees who underwent biometric screens were identified as having undiagnosed “early stage cancer,..resulting in early treatment.” (There were also 26 with later-stage cancer, for a total of 540.)

A tiny Samoan airline has apparently begun charging fares based on a passenger’s weight, reports Patrick Smith in a provocative post on his “Ask The Pilot” blog today.

Smith explains why the practice makes sense for the Samoans (and why it’s extremely unlikely that any major airlines will follow suit). But his piece also underscores an inexorable trend: forcing the overweight and obese pay for their extra pounds.

He writes:

…Americans are quite a bit larger than they used to be, and doesn’t that extra weight affect an airplane’s performance? Is it just a matter of time before passengers on United, Delta or American are asked to stand on a scale, like their suitcases, when checking in?

Well, no. It makes sense if, like Samoa Air, you’re a company operating light, ten-seat aircraft in a region with extremely high rates of obesity, but not if you’re a major carrier with a fleet of Boeings or Airbuses. There are some touchy social and civil liberty aspects that probably make the idea controversial, if not untenable, but let’s take a look at the practical side:

To begin with, passengers account for surprisingly small percentage of a plane’s overall weight. As a general rule, the larger the plane, the less of a factor it is. That sounds counterintuitive, but consider the example of a Boeing 747″>Boeing 747. A 747 typically seats around 420 people, and its maximum allowable takeoff weight is 875,000 pounds. Four hundred and twenty people * and * their carry-on luggage weigh in at just under 80,000 pounds. That’s less than ten percent — ten percent! — of the plane’s maximum heft. Most of what it weighs comes from the mass of the jet itself, plus the fuel load, which runs into the hundreds of thousands of pounds.

So while it appears that obese people are, for now, paying the same fares as everyone else, they are paying more in other realms.

It’s not just obscure airlines.

WBUR’s On Point ran a segment today on the growing practice of big employers charging overweight and obese workers more to pay for their health insurance. “As health care and insurance costs rise, employers increasingly want to know your weight, your blood pressure, your glucose and cholesterol levels. Six in ten, according to one survey, Continue reading →

“Workplace wellness” is a big and burgeoning movement. But is it a bubble?

If you work in a company of any size, chances are you know the “wellness” drill. Your employer is getting killed by health care costs, and tries to bring them down by motivating workers to get healthier. The wellness program offers you incentives — as much as several hundred dollars a year — to fill out a questionnaire on your health risks, get medical tests, lose weight, quit smoking, lower your cholesterol.

What could be bad, right? You win, your company wins. The idea is so appealing that it’s enshrined in the national health overhaul best known as Obamacare, and in the latest groundbreaking health reform moves in Massachusetts. And it has fast become the norm: Most companies that offer health insurance benefits now also offer some sort of wellness plan as well.

Author Al Lewis (Courtesy)

So when Al Lewis takes on the $6-billion wellness industry in his recent book, “Why Nobody Believes The Numbers,” he’d better be packing some good ammo. And he is: Fifth-grade math. Well, sometimes fourth-grade.

Lewis — an expert in “care management” across populations and measuring efforts to improve it — argues that yes, wellness is a bubble, because much of the movement carries a fatal flaw: Its potential economic benefits have been outrageously oversold.

Many wellness program vendors promise companies that they can quickly and cheaply cut their workers’ health costs — and back their claims with numbers that could not survive the most elementary scrutiny, he says. (Lewis titles Chapter 3, “Case Studies That Flunk Every Plausibility Test Known To Mankind.”)

‘The entire economic justification for wellness is made up.’

One example of many, his helpful analogy from the housing world: “If you insulate your house, you should save money overall, but you won’t save money on insulation.”

The health care equivalent is that you need to spend money to save money overall. If you get your workers to go to the doctor more and take more of the drugs they need, you may save money by avoiding hospital stays and ER visits. But — contrary to what some wellness experts claim — you’re not going to see your spending on drugs and doctors go down, too, Lewis says. That would be like saving money on insulation.

“What are these people thinking?” he asks. (On his Website here, he bestows “Intelligent Design Awards” to some of the more egregious overpromisers for “setting back the evolution of the wellness field.”) In essence, he argues, virtually all the data on the wellness Return on Investment — “The entire economic justification for wellness, is made up.” Continue reading →

“Wellness” is like apple pie, isn’t it? What could possibly be bad about companies helping their workers be healthier?

I wouldn’t dream of finding fault with many typical wellness offerings: Quit-smoking programs, on-site gyms, more appealing cafeteria salads. Good for worker, good for employer, everybody’s happy. But consider this email I received from an employee at a major national retailer:

Carey,
I see you’ve written several articles about the new health insurance laws, etc. The company I work for has [a major national insurer]. Last year we received a $25 discount bi-weekly if we filled out a health questionnaire, which of course everyone felt compelled to do as that would be a savings of $650 per year. Most people I spoke to felt uneasy doing it, as they felt it would lead to other invasive practices. Well, sure enough, this year, if you DON’T smoke cigarettes you get $10 off bi-weekly, but to get the additional $25 not only do you have to fill out a questionnaire, but everyone employed [here] (and taking the health insurance) has to have a screening which involves:
1. Waistline measurement
2. Blood pressure measurement
3. Blood draw to test for glucose, HDL and triglyceride levels.
If you do not pass these tests, you will lose your $25 if these are not brought down to an acceptable level by August (when we will be tested again).
Needless to say, this really shook a lot of people up, as it is so invasive, and is this even legal?
Would love to hear your thoughts on this.

Let’s cut to the chase. Yes, it’s legal. And it’s a huge trend that began with only “carrots” — discounts on gym memberships, fun health fairs — and is now progressing to sticks. Or at least, to carrots that can feel a whole lot like sticks.

There are some important limits on what your company’s wellness program can do. More on that soon. But here’s the bottom line: Under federal law, your employer can vary your health insurance premium by up to 20 percent based on a “health factor;” that goes up to 30% as of 2014 and the government could eventually raise it as high as 50%.

Why should you foot the bill for all your Marlboro-packing, Miller-cracking, Big-Mac-chomping co-workers?

Readers, what do you think? On the one hand, if you’re a fit, non-smoking, careful eater, why should you have to help foot the bill for all your Marlboro-packing, Miller-cracking, Big-Mac-chomping co-workers? An unhealthy lifestyle is known to be a major contributor to health care bills. and health costs have skyrocketed for years, sending premiums through the roof, hurting businesses and costing jobs. Any levers to bring them down must surely be tried.

On the other hand, there is clearly a potential yuck factor here. Having my employer measure my waist, or draw my blood??? Getting weighed and monitored in the workplace setting, or in the personnel filing cabinet, may not always be comfortable. What if my boss starts a “fun” pedometer contest among our company’s departments and I’m the morbidly obese one? What about my medical privacy? Continue reading →

If you missed Andrew Dreyfus’ speech last week to the Greater Boston Chamber of Commerce you are forgiven: it wasn’t exactly Fifty Shades of Grey. To be fair though, the president and CEO of the state’s largest health insurer, Blue Cross Blue Shield of Massachusetts, did make some good points about how hard it is to cut health care costs and the historic divisions that make it even harder, among other topics.

To put the problem in perspective for a Boston crowd, Dreyfus (who reportedly is very attached to his pedometer and competes with his daughter to see who can accumulate the most steps daily) offered this health-related metaphor:

“…If health care reform is a marathon, I believe then we are already at about mile 22 – past Boston College – on coverage, and at mile 15 on quality – crossing Wellesley at Route 16, but with those steep Newton hills still ahead. But when it comes to cost, we’re barely to Framingham, with a long, challenging race ahead of us.”

Here, excerpted, are snapshots of his speech:

On The Path To Value

“First, we must hasten the redesign of our system for delivering care and paying for it. Second, we need to promote better health so we spend less time and money treating illness. Third, we must empower patients to play a central role in their care. And finally, we need to bridge some historic divides that subvert our affordability efforts again and again.

On Wellness Vs. Illness

“You’ve heard it before but it’s worth repeating: 50 percent of health care costs are associated with just five percent of patients, and 25% of costs with just 1% of patients. While these expensive patients include a small number of organ transplants, major traumas, and premature infants, the vast majority of spending is for people with multiple chronic illnesses, such as diabetes and coronary artery disease, or renal disease and depression. For these patients, staying healthy requires constant vigilance; they typically have multiple clinicians, multiple prescriptions, and are frequently hospitalized. By putting our focus on the health of the 5% of patients with multiple chronic conditions, we can help them lead healthier lives and reduce costs for all of us.

Some solutions are breathtakingly simple and low-tech, like ensuring patients have a PCP or nurse practitioner who coordinates their team of caregivers, deploying home health aides, social workers, and medical specialists as needed. Other solutions exploit new technology: telemedicine to monitor patients at home, medical records that connect hospitals and physicians offices, and social networks for patients to support one another. Continue reading →

If I had made the same salad in the Tufts Health Plan cafeteria it would have been at least 25% cheaper. Tufts “subsidizes” the fruit and salad bar prices for employees. Hello, are other employers listening?

Tufts isn’t out to compete with other employers. It’s trying to encourage employees to buy salad instead of pizza. In short, to eat healthy. (Warning: Bacon bits don’t count as healthy.)

Tufts says the subsidies are working. The cafeteria sold 661 pounds of salad each week in May 2010. Last week, those Tufts employees ate 915 pounds of salad. But pizza consumption is not down. Hmmm…Are more Tufts employees eating out or are Tufts employees just eating more?

I’ve been thinking about these salad subsidies as I read about renewing the farm bill. Yes, Congress is talking about moving from subsidies to insurance against losses for corn, wheat and other crops that critics say contribute to obesity, but price supports for sugar are still in. And subsidizing salad? Nope – not there – not yet.

BU med students attend yoga class as part of their professional and personal training.

Ben Tannenbaum, a wiry first-year medical student, is under pressure.

His typical day involves about five hours of lectures and test prep — physiology, genetics and histology on a recent weekday; a mad dash off to a clinic to practice as a doctor learning physical exams and basic medical history-taking; and then, after getting home around 8:30 pm, a few more hours of work reviewing the day’s material before it all starts again the next morning.

“And that isn’t including elective courses, student organizations, research, volunteer work, or extracurricular activities that almost everyone is trying to find time for as well,” says Tannenbaum, a-24-year-old student at Boston University School of Medicine.

But on Tuesday night, the perpetual motion of Tannenbaum’s life stopped. He entered a packed classroom, rolled out his blue yoga mat and plopped down on the floor. Alongside 25 other barefoot medical students, Tannenbaum listened to a half-hour talk on “the relaxation response” and how the technique — a simple type of meditation that reduces the activity of the autonomic nervous system — can alleviate stress-related maladies, from migraines to depression.

Then everyone took a deep breath and stretched into downward-facing dog. The yoga part of the medical school’s weekly yoga course had begun.

As everyone knows, medical students are a singularly stressed-out lot. “More than 20 percent end up with depression, more than half suffer from burnout, and in any given year, as many as 11 percent contemplate suicide,” Dr. Pauline Chen writes in a New York Timesreport on the “toxic” nature of the medical education process.

So it makes sense to offer these overwhelmed kids de-stressors like yoga and meditation. But here, at the BU medical school’s first-ever yoga elective the aim is even broader: The faculty and instructors who launched the class hope these future doctors will be able to exploit their knowledge of yoga and its research-based benefits to someday help patients and to feel as comfortable prescribing yoga as they do Prozac. Continue reading →

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Massachusetts is the leading laboratory for health care reform in the nation, and a hub of medical innovation. From the lab to your doctor’s office, from the broad political stage to the numbers on your scale, we’d like CommonHealth to be your go-to source for news, conversation and smart analysis. Your hosts are Carey Goldberg, former Boston bureau chief of The New York Times, and Rachel Zimmerman, former health and medicine reporter for The Wall Street Journal.GET IN TOUCH

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Massachusetts is the leading laboratory for health care reform in the nation, and a hub of medical innovation. From the lab to your doctor’s office, from the broad political stage to the numbers on your scale, we’d like CommonHealth to be your go-to source for news, conversation and smart analysis. Your hosts are Carey Goldberg, former Boston bureau chief of The New York Times, and Rachel Zimmerman, former health and medicine reporter for The Wall Street Journal.

If they’re so effective, why aren’t more women using IUDs and implants? A health clinic in Worcester is getting help to put better birth control front and center — particularly long-acting birth control, in hopes of cutting the high rate of unintended pregnancy.